Health Law Daily Medicaid programs have thrived with telehealth services during COVID-19 emergency
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Tuesday, July 27, 2021

Medicaid programs have thrived with telehealth services during COVID-19 emergency

By Joe Cox, J.D.

During the Covid-19 Public Health Emergency, CMS and states saw historic increases in the telehealth programs.

While Medicaid telehealth services had been available for years, the COVID-19 emergency greatly increased interest and utilization of such services within state programs, according to an ASPE issue brief. Telehealth is not a discrete service but is a mode of delivery. Telehealth services include real-time audio or video visits where the care is provided by a practitioner located at a different site than the patient and/or text or telephone communications. States have the flexibility to determine what services and providers may utilize telehealth and what payment rates to providers will be. A 2019 (and thus, pre-COVID 19) survey indicated a wide range of policies and barriers to utilization of telehealth across seven different states. Among the most substantial issues noted was a general lack of clarity about which services could be provided and the reimbursement policies in question. Older and urban users tended to avoid telehealth technology, with most users being rural and most issues addressed involving behavioral health services and prescriptions. (APSE Issue Brief, HP-2021-17, July 19, 2021).

During the COVID-19 pandemic, the HHS and OCR issued a notice that penalties would not be issued for HIPAA non-compliance in connection with good-faith provision of telehealth. This cleared the way for Zoom, Skype, Apple FaceTime, and Facebook Messenger communication with patients, in addition to HIPAA-compliant platforms like Skype and Microsoft Teams. Meanwhile, the DEA waived in-patient medical evaluation requirements for prescription of controlled substances and the CMS offered an accelerated approval process for SPAs related to telehealth offerings.

Accordingly, states greatly increased availability of telehealth offerings. Before the pandemic, all states plus the District of Columbia allowed some services to be delivered via telehealth offerings under Medicaid, with behavioral services (47 states) and primary care services (36 states) being among the most common offerings. Some of the less-frequently approved offerings included physical, occupational, and speech therapy (16 states), maternity care (15 states), and home and community-based services (14 states). During the pandemic, though, all states allowed behavioral services and primary care services to be offered, with 49 supporting telehealth offerings of physical, occupational, and speech therapy. 41 allowing for telehealth home and community-based services, and 31 providing for telehealth maternity care.

Some aspects of the changes were particularly noteworthy. Before the pandemic, no states allowed for telephone-only communication within supported telehealth procedures. During the pandemic, all states did so. Text-based communication had been allowed in only three states, but that number increased to 17 states during the pandemic.

Overall, telehealth services increased from less than 6 telehealth services per 1,000 Medicaid and CHIP beneficiaries provided before the pandemic to more than 150 such services per 1,000 Medicaid and CHIP beneficiaries from February to April 2020. While those rates did decline some in following months, they remained many times higher than before the pandemic. Some concerns were noted-- particularly that older, lower-income, black, Hispanic, or Asian beneficiaries (as well as people with limited English proficiency) tended to utilize telehealth less than others.

Overall, while telehealth services have been rolled back since early 2020, the increased use of telehealth offerings suggests significant possibilities moving forward. While there are issues to consider, such as inconsistencies in billing and reimbursement across the states and how to improve telehealth experiences for minority beneficiaries, the ASPE notes that the extent and circumstances for telehealth flexibilities after the pandemic are significant questions for further evaluation.

MainStory: TopStory AgencyDocuments CMSNews CoverageNews Covid19 HIPAANews MedicaidNews

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